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It was a routine call….checking in on a client about his case…. I was not expecting what I heard.

The news on the other end of the line wasn’t good.  He had just been through months of tests to figure out what was going on inside his body.

Weird symptoms had been presenting.

First some dizziness, and some significant memory loss.  Then he started to lose his vision, a little bit here and a little bit there.    I noticed in past conversations that he was having a lot of difficulty saying words, and more difficulty understanding what I would say to him.

“They diagnosed it today,” he said. “Vascular dementia.”

“It gets worse,” he added. “They said my kidney problem was like a chain of dominoes inside my body – this is just the first to fall.”  

The Veteran had service-connected Renal Dysfunction from his Vietnam era service.  But it was nothing more than a major inconvenience – he could still work, go hunting, occasionally ride a motorcycle (against his better judgment, he always told me with a wink). 

The Vascular Dementia – a condition that is somewhat similar to Alzheimer’s in its symptoms, but completely different in its causation – would quickly rob him of his ability to earn an income and provide for his family.

This is where Secondary Service Connection comes in.

There are 5 different ways to show that any medical condition is somehow related to your military service.

Most Veterans – believe it or not – don’t know this.

Nor do they know that you can – and should – argue more than one way that your disability is service connected.

I am not going to talk about all 5 here today.

If  you want to learn about all 5 Paths – what they are, how to prove them, when to use them, how many to use, etc. – you should check out my VA Field Manual (eBook) “5 Paths to Service Connection”

Today I just want to talk to you about one of those paths: Secondary Service Connection.

There is not always a nice straight line between an in-service injury and a medical condition.  Sometimes a service-connected injury can cause another injury or condition.

Why is this?

Because the parts of the human body do not work in isolation.

Your heart pumps oxygen to your body.

If you have a problem with your “pump”, you may likely have problems with your blood pressure.

If you have problems with your blood pressure, you may cause problems with your vascular system.

Vascular problems can lead to organ problems.

Organ problems can lead to cancers.

You get the idea.

Because the parts of the human body do not work in isolation, you may find yourself with a medical condition that did not arise in military service.  Just like my client in the above example – his Vascular Dementia did  not arise in service.

But because it was caused by a condition that WAS service-connected, he is able to file a claim and seek compensation for it.

If he dies from the condition – he’ll be the first to tell you that his Vascular Dementia will kill him long before his renal dysfunction – his wife will be eligible for survivor benefits and his kids will be eligible for Dependents Educational Assistance (aka, DEA).

Secondary service connection can be a big deal.

If this is the case, then you are going to want to tell the VA you are claiming service connection based on a legal theory of “Secondary service connection”.

(Don’t confuse this with the theory of service connection by aggravation – when a service-connected condition makes another  pre-existing or non-service connected condition worse).

Here is what you Need to Prove Secondary Service Connection.

Medical evidence.  Short and simple.

You will not succeed in a secondary service-connection claim without sufficient medical evidence.

Why not?   Because lay evidence is often insufficient to establish medical causation.

That makes sense, right? You don’t go to a yoga instructor to tell you why your car’s “check engine” light is coming on.  You go to someone that is trained in diagnosing that problem.

Likewise, in a secondary service connection claim, you will have to have a medical doctor offer an opinion that your condition was caused by – or resulted from – a service connected condition.

The legal burden of proof you need to meet is , however, the same as any other service connection claim: the doctor only needs to conclude: It is “at least as likely as not” that Service-connected Condition A caused Condition B.


Examples of Proving Secondary Service Connection.

Scenario 1: As a result of a combat injury, you are diagnosed with post-traumatic stress  (aka, PTSD), depression or any other mental health condition. That mental health condition leads to stomach problems.  Are the stomach problems able to be service connected using secondary service connection?

Answer: Probably. You will need medical opinions from a gastroenterologist and probably a psychiatrist or psychologist to show the VA that the stomach disorder is the result of, or caused by, the mental health condition.

Scenario 2: (This general scenario appears in the Veterans Benefits Manual, page 132.) A veteran has a 30% rating for a service-connected knee injury. As a result of that injury, the veteran now complains of chronic back-pain and walks with a limp. Is the low-back pain and limp a secondary connection?

Answer: It depends. If you have an opinion from a private medical expert, you may be able to establish that the second injury, the low back pain, is connected to the original knee problem. This is a tougher claim, because there are many causes for low back-pain.

Scenario 3:  You had a Traumatic Brain Injury while in-service, and as a result, suffered nerve damage in your brain.  You have now been diagnosed with sleep apnea – and  there is no evidence that sleep apnea was diagnosed in service.  Is your sleep apnea secondary to your TBI?

Answer: It could be – but you’re going to need some medical evidence to show that.  One form of sleep apnea results from nerve damage: the brain cannot send the proper signals to the lungs to expand and take in air.  Sleep Apnea is a deadly condition – and there are many causes for the condition.

How to learn more about Proving Secondary Service Connection.

VA Claims can seem tough at first – but they don’t need to be.

Can I  teach you my 8 Steps for Improving Your VA Claim? My law firm uses this same 8 step method in the work we do for clients. I developed it by reading hundreds, if not thousands, of VA Claims Files.

I saw patterns in the claims that the VA continually delayed and denied, and I want to  show YOU how to fix those patterns and problems.

You can learn all about the 8 Steps – and how to use them in fixing your VA Claim – in the thousands of posts and videos here on the Veterans Law Blog. Don’t have time to dig through the blog for the information?  I’ll send it to you by email.

I can send you more information by email from the Veterans Law Blog, which will include tips, pointers, guidance, examples and a variety of other tools you can use to take back the power in your VA claim and get on with your life.




  1. Kevin Murszewski


    I seperated back in ’96, I went home to NY and in ’97 completed and sent in my initial paperwork to the VA. Nice and simple nothing complicated just getting the process started. I never heard back on my initial application and forgot about it. In 2000 I moved to CO, in 2002 I decided perhaps I would have better luck resubmitting in CO so I did, filled out the application again and resubmitted it. Again same issue never heard back and forgot about it until recently, in the last two years I know I should approach the issue again but I am so fed up now with the process I don’t want to waste my time even though only something good should happen. It’s neither here nor there but my question is how many vets out there cant even access the system? How many vets just don’t continue because they don’t want to deal with a system that doesn’t work? I cant be the only one to have slipped through two cracks

    Thank you,

    • Chris Attig

      Kevin, you raise a great point. By the numbers, there are 21 million Veterans (roughly) in the US. Only 3 million are service-connected disabled. Given the sheer number of Veterans that served in combat, and the dangerous nature of military work, I think that there are probably MILLIONS who either don’t know about the benefits they are entitled to, or who just gave up, as you say.

      That’s one of the things I hope this blog changes…we reach over 26,000 Veterans a month – on the blog, on social media, and by email. I know of several that have used the information to get a favorable decision on a claim that they previously gave up on.



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